A 70-year-old male presents with loss of sensation in external auditory meatus (Hitselberger sign positive). The likely diagnosis is:
**Question:** A 70-year-old male presents with loss of sensation in external auditory meatus (Hitselberger sign positive). The likely diagnosis is:
A. Spinal cord injury
B. Cervical radiculopathy
C. Trigeminal neuralgia
D. Glossopharyngeal neuralgia
**Core Concept:**
The Hitselberger sign is a clinical test used to assess the integrity of the trigeminal nerve. The trigeminal nerve is a mixed sensory and motor nerve, responsible for sensation in the face, including the external auditory meatus. The test involves pinching the patient's nose and observing if they can feel the pinch in the external auditory meatus. A positive test indicates impaired function of the trigeminal nerve, which could be due to various causes.
**Why the Correct Answer is Right:**
In this case, the patient presents with loss of sensation in the external auditory meatus, which is a key feature of trigeminal neuralgia (TN). TN is a neuropathic pain disorder characterized by severe, spontaneous, and brief paroxysms of pain in the distribution of the trigeminal nerve. The Hitselberger sign is positive in this case, indicating impaired function of the trigeminal nerve.
**Why Each Wrong Option is Incorrect:**
A. Spinal cord injury: This would affect the entire body and not just the external auditory meatus.
B. Cervical radiculopathy: This is a condition affecting a single nerve root, usually caused by disc herniation or spinal stenosis, and would not specifically affect the external auditory meatus.
C. Trigeminal neuralgia: This is the correct diagnosis, as mentioned above.
D. Glossopharyngeal neuralgia: This affects the glossopharyngeal nerve, which is different from the trigeminal nerve and would not cause the described symptoms.
**Clinical Pearl:**
The Hitselberger sign can be a valuable tool in distinguishing trigeminal neuralgia from other neurological conditions. In cases of suspected trigeminal neuralgia, a thorough neurological examination and history-taking are crucial to confirm the diagnosis, as it might not be evident from the Hitselberger sign alone.
**Why Each Wrong Option is Incorrect:**
A. Spinal cord injury: This would affect the entire body and not just the external auditory meatus.
B. Cervical radiculopathy: This is a condition affecting a single nerve root, usually caused by disc herniation or spinal stenosis, and would not specifically affect the external auditory meatus.
C. Trigeminal neuralgia: This is the correct diagnosis, as mentioned above.
D. Glossopharyngeal neuralgia: This affects the glossopharyngeal nerve, which is different from the trigeminal nerve and would not cause the described symptoms.